In examining the heterogeneity of symptomatology in schizophrenia, several theoretical models have been advanced. These models are useful in understanding the psychopathology of the disease, as well as possibly guiding treatment and determining prognosis. This paper discusses the two-syndrome and three-syndrome models for the primary symptoms of schizophrenia and their relationship to other symptoms often encountered. In addition, their significance and relevance for treatment are explored.
References
1.
CrowT.J.Molecular pathology of schizophrenia: more than one dimension of pathology?Br Med J1980; 280: 66–68.
2.
AndreasenN.C.Negative symptoms in schizophrenia: definition and reliability.Arch General Psychiatry1982; 39: 789–794.
3.
CrowT.J.The two-syndrome concept: origins and current status.Schizophr Bull1985; 11: 471–485.
4.
JohnstoneE.C., CrowT.J., FrithC.D.Mechanism of the antipsychotic effect in the treatment of acute schizophrenia.Lancet1978; i: 848–851.
5.
AndreasenN.C., FlaumM., SwayzeV.W.Positive and negative symptoms in schizophrenia: a critical reappraisal.Arch Gen Psychiatry1990; 47: 615–621.
6.
AndreasenN.C., OlsenS.Negative versus positive schizophrenia.Arch Gen Psychiatry1982; 39: 789–794.
7.
CarpenterW.T.Jr, HeinrichsD.W., WagmanA.M.I.Deficit and non-deficit forms of schizophrenia1, the concept.Am I Psychiatry1988; 145: 578–583.
MortimerA.M., McKennaP.J., LundC.E.Rating of negative symptoms using the HEN.Br J Psychiatry1989; 155(7 Suppl): 89–92.
11.
AndreasenN.C.The Scale for Positive Symptoms (SAPS).Iowa City IA: University of Iowa, 1984.
12.
AndreasenN.C.The Scale for Assessment of Negative Symptoms (SANS).Iowa City IA: University of Iowa, 1983.
13.
KayS.R., FiszbeinA., OplerL.A.The Positive and Negative Syndrome Scale (PANSS) for Schizophrenia.Schizophr Bull1987; 13: 261–276.
14.
WalkerE.F., HarveyP.D., PerlmanD.The positive/negative symptom distinction in psychoses: a replication and extension of previous findings.J Nerv Ment Dis1988; 176: 359–363.
15.
SchuldbergD., QuinlanD.M., MorgensternH.Positive and negative symptoms in chronic psychiatric outpatients: reliability, stability, and factor structure.Psychol Assess1990; 2: 262–268.
16.
KayS.R., SinghM.M.The positive-negative distinction in drug-free schizophrenic patients: stability, response to neuroleptics, and prognostic significance.Arch Gen Psychiatry1989; 46: 711–718.
17.
ArndtS., AlligerR.J., AndreasenN.C.The distinction of positive and negative symptoms: the failure of a two dimensional model.Br J Psychiatry1991; 158: 317–322.
18.
KulharaP., KotaS.K., JosephS.Positive and negative subtypes of schizophrenia: a study from India.Acta Psychiatr Scand1986; 74: 353–359.
19.
LiddleP.F.The symptoms of chronic schizophrenia: a reexamination of the positive-negative dichotomy.Br J Psychiatry1987; 151: 145–151.
20.
LiddleP.F., BarnesT.R.Syndromes of chronic schizophrenia.Br J Psychiatry1990; 157: 558–561.
21.
MallaA.K., NormanR.M.G., WilliamsonP.Three syndrome concept of schizophrenia: a factor analytic study.Schizophr Res1993; 10: 143–150.
22.
LiddleP.F., FristenK.J., FrithC.D.Patterns of cerebral blood flow in schizophrenia.Br J Psychiatry1992; 160: 179–186.
23.
Earle-BoyerE.A., LevinsonJ.C., GrantR.The consistency of thought disorder in mania and schizophrenia: II. An assessment of consecutive admissions.J Nerv Ment Dis1986; 174: 443–447.
24.
HarveyP.D., Earle-BoyerE.A., WeilgusM.S.The consistency of thought disorder in mania and schizophrenia: an assessment of acute psychotics.J Nerv Ment Dis1984; 172: 458–463.
25.
LindenmayerJ.P., KayS.R., FriedmanC.Negative and positive schizophrenia syndromes after the acute phase. A prospective follow-up.Compr Psychiatry1986; 27: 276–286.
26.
RaginA.B., Pogue-GeileM.F., OltmatisT.F.Poverty of speech in schizophrenia and depression during inpatient and post-hospital periods.Br J Psychiatry1989; 154: 52–57.
27.
BiehlH., MaurerK., SchubartC.Prediction of outcome and utilization of medical services in a prospective study of first onset schizophrenics.Euro Arch Psychiatry Neurolog Sci1986; 236: 139–147.
28.
McGlashanT.H., FentonW.S.The positive-negative distinction in schizophrenia: review of natural history validators.Arch Gen Psychiatry1992; 49: 63–72.
29.
MallaA.K., NormanM.G., WilliamsonP.Stability of positive and negative symptoms in schizophrenia.Can J Psychiatry1993; 38(9): 617–621.
30.
GoldbergS.C., Negative and deficit symptoms in schizophrenia do respond to neuroleptics.Schizophr Bull1985; 11: 453–456.
31.
BreierA., OwenM., WolkowitzNeuroleptic responsivity of negative and positive symptoms in schizophrenia.Am J Psychiatry1987; 144(12): 1549–1555.
32.
MeltzerH.Y.Pharmacologic treatment of negative symptoms. In: GredenJ.F., TandonR., eds. Negative schizophrenic symptoms: pathophysiology and clinical implications.Washington DC: American Psychiatric Press,1991.
33.
MarderS.R., MeibachC.Risperidone in the treatment of schizophrenia.Am J Psychiatry1994; 151(6): 825–835.
34.
LihdenmayerJ.P., KayS.R.Depression, affect and negative symptoms in schizophrenia.Br J Psychiatry1989; 155(7 Suppl): 108–114.
35.
SirisS.G., AdamF., CohenM.Post-psychotic depression and negative symptoms: an investigation of syndromal overlap.Am J Psychiatry.1988; 145: 1532–1537.
36.
HirschS.R., JolleyA.G., BarnesT.R.E.Dysphoric and depressive symptoms in chronic schizophrenia.Schizophr Res1989; 2: 259–264.
37.
NormanR.M.G., MallaA.K.Dysphoric mood and symptomatology in schizophrenia.Psychol Med1991; 21: 897–903.
38.
NormanR.M.G., MallaA.K.Correlations over time between dysphoric mood and symptomatology in schizophrenia.Compr Psychiatry1994; 35(1): 34–38.
39.
AddingtonD., AddingtonJ., Maticka-TyndaleE.Assessing depression in schizophrenia: the Calgary Depression Scale.Br J Psychiatry1993; 163(22 Suppl): 39–44.
40.
HerzM., MelvilleC.Relapse in schizophrenia.Am J Psychiatry1980; 137: 801–805.
41.
KumarS., TharaR., RajkumarS.Coping with symptoms of relapse in schizophrenia.Euro Arch Psychiatr Neurol Sci1989; 239: 213–215.
42.
HirschS.R., JollyA.G.The dysphoric syndrome in schizophrenia and its implications for relapse.Br J Psychiatry1989; 155(5 Suppl): 46–50.
43.
BirchwoodM., SmithJ., MacMillanF.Predicting relapse in schizophrenia: the development and implementation of an early signs monitoring system using patients and families as observers, a preliminary investigation.Psychol Med1989; 19: 649–656.
44.
TarrierN., BarrowcloughC., BamrahJ.S.Prodromal signs of relapse in schizophrenia.Soc Psychol Psychiatr Epidem1991; 26: 157–161.
45.
MallaA.K., NormanR.M.G.Prodromal symptoms in schizophrenia.Br J Psychiatry1994; 164: 487–493.
46.
MarderS.R., WirshingW.C., Van PuttenT.Fluphenazine versus placebo supplementation for prodromal signs of relapse in schizophrenia.Arch Gen Psychiatry1994; 51: 280–287.
47.
QuitkinF., RifkinA., KleinD.F.Neurologic soft signs in schizophrenia and character disorders.Arch Gen Psychiatry1976; 33: 845–853.
48.
CoxS.M., LudwigA.M.Neurologic soft signs and psychopathology. I. Findings in schizophrenia.J Nerv Ment Dis1979; 167(3): 161–165.
49.
HeinrichsD.W., BuchananR.W.Significance and meaning of neurological signs in schizophrenia.Am J Psychiatry1988; 145: 11–18.
50.
KingD.J., WilsonA., CooperS.J.The clinical correlates of neurological soft signs in chronic schizophrenia.Br J Psychiatry1991; 158: 770–775.
51.
TurnerT.H.A diagnostic analysis of the case books of Tilehurst House Asylum (1845–1890). Monograph Supplemental. Psychol Med. New York NY: Cambridge University Press,1992.
52.
RogersD.The motor disorders of severe psychiatric illness: a conflict of paradigms.Br J Psychiatry1985; 147: 221–232.
53.
LiddleP.F.Schizophrenic syndromes, cognitive performance and neurological dysfunction.Psycholog Med1987; 16: 49–57.
54.
LiddleP.F., HaqueS., MorrisD.L.Dyspraxia and agnosia in schizophrenia.Behav Neurol1993; 6: 49–54.